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Purpose <p>To evaluate whether follicle size at hCG trigger influences reproductive outcomes in letrozole-modified natural frozen embryo transfer (let-mNC-FET) cycles among high-responder patients.</p> Methods <p>This observational cohort included 170 let-mNC-FET cycles. Patients were stratified by follicle-size percentiles at trigger: 0–25th (15–17&#xa0;mm; <i>n</i> = 43), 25–75th (18–20&#xa0;mm; <i>n</i> = 90), and &gt; 75th (21–24&#xa0;mm; <i>n</i> = 37). Oral dydrogesterone provided luteal support. Serum progesterone (P4) on embryo-transfer (ET) day was measured with an assay that does not detect dydrogesterone (reflecting endogenous luteal production). The primary outcome was the ongoing pregnancy rate (OPR). Group comparisons used ANOVA/Kruskal–Wallis and <i>χ</i><sup>2</sup> tests; predictors of OPR were evaluated with logistic regression.</p> Results <p>Positive hCG and OPR did not differ across percentile groups (51.2%, 52.2%, 55.6%; <i>p</i> = 0.920 and 48.8%, 50.0%, 52.7%; <i>p</i> = 0.833, respectively). Endometrial thickness at trigger differed by group (medians 8.0, 9.0, 7.8&#xa0;mm; <i>p</i> &lt; 0.001), while ET-day P4 increased with larger follicles (medians 19.74, 21.00, 26.50&#xa0;ng/mL; <i>p</i> = 0.001; post-hoc 0–25th vs &gt; 75th <i>p</i> = 0.0009). In multivariable analysis, younger age (aOR 0.834; 95% CI 0.762–0.914; <i>p</i> = 0.0001), higher BMI (aOR 1.169; 1.015–1.346; <i>p</i> = 0.0303), fewer stimulation days (aOR 0.798; 0.647–0.983; <i>p</i> = 0.0343), larger leading follicle size (aOR 1.343; 1.059–1.703; <i>p</i> = 0.0151), and higher ET-day P4 (aOR 1.067; 1.027–1.108; <i>p</i> = 0.0007) independently predicted OPR; EMT and AMH were not associated (<i>p</i> ≥ 0.08 and <i>p</i> = 0.25).</p> Conclusions <p>Although OPR did not differ across follicle-size strata, larger follicle size at trigger and higher endogenous luteal P4 were independent predictors of OPR in highresponders. Confirmation in adequately powered prospective studies is warranted.</p>

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Impact of Follicle Size at Trigger on Reproductive Outcomes in Letrozole-Modified Natural Frozen Embryo Transfer Cycles in High Responder Patients

  • 期刊论文

  • 发表日期：

    2025年11月13日

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  • Emre Pabuccu,
  • Christophe Blockeel,
  • Ugras Ucar,
  • Recai Pabuccu

摘要

Purpose

To evaluate whether follicle size at hCG trigger influences reproductive outcomes in letrozole-modified natural frozen embryo transfer (let-mNC-FET) cycles among high-responder patients.

Methods

This observational cohort included 170 let-mNC-FET cycles. Patients were stratified by follicle-size percentiles at trigger: 0–25th (15–17 mm; n = 43), 25–75th (18–20 mm; n = 90), and > 75th (21–24 mm; n = 37). Oral dydrogesterone provided luteal support. Serum progesterone (P4) on embryo-transfer (ET) day was measured with an assay that does not detect dydrogesterone (reflecting endogenous luteal production). The primary outcome was the ongoing pregnancy rate (OPR). Group comparisons used ANOVA/Kruskal–Wallis and χ2 tests; predictors of OPR were evaluated with logistic regression.

Results

Positive hCG and OPR did not differ across percentile groups (51.2%, 52.2%, 55.6%; p = 0.920 and 48.8%, 50.0%, 52.7%; p = 0.833, respectively). Endometrial thickness at trigger differed by group (medians 8.0, 9.0, 7.8 mm; p < 0.001), while ET-day P4 increased with larger follicles (medians 19.74, 21.00, 26.50 ng/mL; p = 0.001; post-hoc 0–25th vs > 75th p = 0.0009). In multivariable analysis, younger age (aOR 0.834; 95% CI 0.762–0.914; p = 0.0001), higher BMI (aOR 1.169; 1.015–1.346; p = 0.0303), fewer stimulation days (aOR 0.798; 0.647–0.983; p = 0.0343), larger leading follicle size (aOR 1.343; 1.059–1.703; p = 0.0151), and higher ET-day P4 (aOR 1.067; 1.027–1.108; p = 0.0007) independently predicted OPR; EMT and AMH were not associated (p ≥ 0.08 and p = 0.25).

Conclusions

Although OPR did not differ across follicle-size strata, larger follicle size at trigger and higher endogenous luteal P4 were independent predictors of OPR in highresponders. Confirmation in adequately powered prospective studies is warranted.